老年原发性高血压与血小板功能的相关性研究

目的探讨老年原发性高血压与血小板功能的关系及其临床意义。方法选择老年原发性高血压60例作为观察组,健康老人30例作为对照组,用流式细胞仪观察两组血小板膜糖蛋白(GP)Ⅱb/Ⅲa的百分率,同时检测血小板聚集率(PAgT)、凝血四项、纤维蛋白原(Fg)、红细胞(RBC)、白细胞(WBC)、血小板(PLT)等指标的变化。结果GPⅡb/Ⅲa的百分率及PAgT在老年原发性高血压患者明显高于对照组(P<0.01),Fg、PLT、凝血酶原时间(PT)、凝血酶原活动度(PA)、部分凝血活酶时间(APTT)、国际化标准值(INR)、RBC、WBC等指标两组未见明显差异性(P>0.05)。老年原发性高血压患者的GPⅡb/Ⅲa百分率与PAgT呈正相关(r=0.732、P<0.01)。结论老年原发性高血压病患者存在血小板异常活化,了解血小板活化状态、抑制其活性,对预防、降低或延缓高血压患者病情发展及其并发症的发生有重要意义。     

Platelet glycoprotein IIb/IIIa receptor antagonists in cardiovascular disease

CONTEXT: Thrombus formation on disrupted atherosclerotic plaque is the major cause of acute coronary events. Platelet inhibitors are the mainstay of drug therapy to reduce cardiac events in patients with acute coronary syndromes. The platelet glycoprotein (GP) IIb/IIIa receptor is the final common pathway of platelet aggregation. OBJECTIVES: To review mechanisms of platelet activation and aggregation and the role of the GP IIb/IIIa receptor in the acute coronary syndromes and to summarize completed clinical trials of GP IIb/IIIa receptor antagonists. DATA SOURCES: English-language journal articles, reviews from a MEDLINE search from 1993 through 1998, as well as abstracts and presentations from major national or international cardiology meetings through November 1998. STUDY SELECTION/DATA EXTRACTION: Randomized, placebo-controlled clinical trials testing intravenous GP IIb/IIIa receptor antagonists and having more than 500 subjects were included. Data quality and validity included publication or presentation venue. DATA SYNTHESIS/CONCLUSIONS: The GP IIb/IIIa receptor is the final common pathway of platelet aggregation. Intravenous monoclonal antibody and peptide and nonpeptide antagonists of the GP IIb/IIIa receptor have been tested in randomized, placebo-controlled trials of the acute coronary syndromes and percutaneous coronary interventions. For patients undergoing percutaneous revascularization, these agents have demonstrated efficacy in reducing death, myocardial infarction, or urgent reintervention. Odds ratios of death or myocardial infarction at 30 days range from 0.42 to 0.84 for the drugs in these studies. More modest benefits have been seen in trials of IIb/IIIa receptor antagonists for patients with the acute coronary syndromes, with odds ratios for death or myocardial infarction at 30 days ranging from 0.70 to 0.89. The efficacy of oral agents for chronic GP IIb/IIIa receptor antagonism has not been sufficiently studied.     

血小板GPⅡb/Ⅲa拮抗剂RGDS和钙通道拮抗剂Nifedipine对GPIIb/IIIa活化的影响

目的：探讨GPⅡb/Ⅲa 拮抗剂RGDS和钙通道拮抗剂Nifedipine对ADP诱导的血小板GPⅡb/Ⅲa活化的影响。方法GP II b／11I a特异性抗体PAC-1标记活化GP II b／11I a,流式细胞仪检测静息及 ADP（5μmol/L）诱导的血小板PAC-1表达率。结果静息状态下的血小板PAC-1表达率为（0.80±0.85）％;在ADP（5μmol/L）激动下,PAC-1表达率为（77.27±9.47）%;RGDS以浓度依赖性的方式抑制PAC-1表达率,IC50值为206μmol/L;Nifedipine能以浓度依赖性的方式抑制PAC-1表达率,IC50值为178μmol/L;RGDS联合Nifedipine对PAC-1表达的联合抑制率为（60.15±16.35）％,二者的交互效应差异有统计学意义（P〈0.05）。结论GPIIb/IIIa受体拮抗剂RGDS和Ca2＋拮抗剂Nifedipine均抑制ADP诱导的血小板GPIIb/IIIa活化,其抑制作用呈浓度依赖性,随拮抗剂浓度增加抑制作用增强;两者对血小板GPIIb/IIIa活化的抑制存在协同作用。     

西洋参与丹参配伍对大鼠颈动脉血栓形成的影响

目的 探讨西洋参、丹参配伍对三氯化铁(FeCl3)诱导的大鼠颈动脉血栓形成的干预作用.方法 50只SD雄性大鼠随机分为假手术组(Sham组)、模型组(Model组)、阿司匹林组(ASA组),西洋参、丹参配伍水煎剂低剂量组(PSDL组)、高剂量组(PSDH组),每组10只,灌胃给药14 d后,应用含20μl 30％FeC...     

活化血小板葡萄糖摄取及血小板膜整合素对其的影响

目的：了解活化血小板葡萄糖摄取过程及血小板膜整合素对其影响，探讨整合素与血小板能量代谢的关系，旨在研究血小板能量代谢涉及的信号传导，并为目前临床应用血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)单抗抗血小板活化提供新的理论依据。方法：用液态闪烁计数方法检测在血小板膜糖蛋白Ⅱb/Ⅲa单抗10E5及血小板整合素αvβ3单抗609干预与否情况下凝血酶激活后血小板摄取氚标2－脱氧葡萄糖[^3H]2-DG)率。结果：在生理浓度范围内活化血小板[^3H]2-DG摄取率较静息时明显升高，单抗10E5可充分阻断活化血小板葡萄糖摄取，单抗609可部分阻断。结论：整合素家族单抗可抑制血小板激活后葡萄糖摄取，提示其可能参与血小板能量代谢信号传导过程，并可能以GPⅡb/Ⅲa为主。     

Effect of Xiaoyu Zhixue tablet on expression of platelet membrane glycoproteins in patients with hemorrhagic thrombopathy

Objective: To observe the effect of Xiaoyu Zhixue tablet (XYZXT) on the expression of platelet membrane glycoproteins in patients with hemorrhagic thrombopathy, and to explore its possible mechanism. Methods; The total of 148 patients with hemorrhagic thrombopathy were randomly divided into two groups, the traditional Chinese medicicne (TCM) group (n = 98) treated with XYZXT and the Western medicine (WM) group (n = 50) treated with adrenosin, vitamins C, K and P, both for 6 months. The therapeutic effect and the recovery rate of platelet aggregation in the two groups were observed. And platelet membrane glycoprotein (GP) Ib/IX, GPII b/IIIa complexes, GPIb, GPIIb, GPIIIa and P-selectin were analyzed by flow cytometry in both groups before and after treatment and also in 34 normal healthy subjects.Results: The total effective rate of hemostasis was 89.8% in TCM group and 54.0% in the WM group (X ²=45.83,P<0.01), and the recovery rate of platelet aggregation was 72.4% and 4.0% respectively (X ² = 62.06,P<0.01). The fluorescence intensity of GP I b/IX, GP II b/III a complexes, GPIb, GP IIIa and P-selectin were lower in both groups before treatment than those in the healthy subjects. Expression of above-mentioned marks was elevated in TCM group after 6 months’ therapy, which was insignificantly different as compared with the healthy subjects (P>0.05) and higher than those in the WM group (P<0.05).Conclusion: One of the mechanisms in treating hemorrhagic thrombopathy with XYZXT is that it could regulate the expression of GP I b/IX, GPII b/IIIa complexes, GP I b, GPIIIa and P-selectin at the level of receptor protein. Supported by the National Natural Science Foundation of China (No. 30171194)     

Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial

Context  The direct thrombin inhibitor bivalirudin has been associated with better efficacy and less bleeding than heparin during coronary balloon angioplasty but has not been widely tested during contemporary percutaneous coronary intervention (PCI). Objective  To determine the efficacy of bivalirudin, with glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibition on a provisional basis for complications during PCI, compared with heparin plus planned Gp IIb/IIIa blockade with regard to protection from periprocedural ischemic and hemorrhagic complications. Design, Setting, and Participants  The Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)–2 trial, a randomized, double-blind, active-controlled trial conducted among 6010 patients undergoing urgent or elective PCI at 233 community or referral hospitals in 9 countries from October 2001 through August 2002. Interventions  Patients were randomly assigned to receive intravenous bivalirudin (0.75-mg/kg bolus plus 1.75 mg/kg per hour for the duration of PCI), with provisional Gp IIb/IIIa inhibition (n = 2999), or heparin (65-U/kg bolus) with planned Gp IIb/IIIa inhibition (abciximab or eptifibatide) (n = 3011). Both groups received daily aspirin and a thienopyridine for at least 30 days after PCI. Main Outcome Measures  The primary composite end point was 30-day incidence of death, myocardial infarction, urgent repeat revascularization, or in-hospital major bleeding; the secondary composite end point was 30-day incidence of death, myocardial infarction, or urgent repeat revascularization. Results  Provisional Gp IIb/IIIa blockade was administered to 7.2% of patients in the bivalirudin group. By 30 days, the primary composite end point had occurred among 9.2% of patients in the bivalirudin group vs 10.0% of patients in the heparin-plus-Gp IIb/IIIa group (odds ratio, 0.92; 95% confidence interval, 0.77-1.09; P = .32). The secondary composite end point occurred in 7.6% of patients in the bivalirudin vs 7.1% of patients in the heparin-plus-Gp IIb/IIIa groups (odds ratio, 1.09; 95% confidence interval 0.90-1.32; P = .40). Prespecified statistical criteria for noninferiority to heparin plus Gp IIb/IIIa were satisfied for both end points. In-hospital major bleeding rates were significantly reduced by bivalirudin (2.4% vs 4.1%; P<.001). Conclusions  Bivalirudin with provisional Gp IIb/IIIa blockade is statistically not inferior to heparin plus planned Gp IIb/IIIa blockade during contemporary PCI with regard to suppression of acute ischemic end points and is associated with less bleeding.      

Studies of human platelet ultrastructure and quantitative analyses of membrane glycoprotein IIB/IIIA in shear stress-induced platelet quick release reaction.

The ultrastructural characteristics of platelets and the quantitative analysis of membrane glycoprotein (GP) IIb/IIIa quick-release reaction induced by high shear stress (HSS) were studied with transmission electron microscope and immunocolloidal gold staining. The results showed that platelets were activated and aggregated by HSS (50 dynes/cm2 or 100 dynes/cm2). Besides, HSS also caused a special platelet quick-release reaction which was called granule-membrane-fused lytic release (GFLR). GFLR differed from releases I and II which were induced by ADP and thrombin respectively. Granules were released quickly and lysis occurred when all granules had been discharged in GFLR. GFLR is a special form of platelet quick release induced by HSS and is called release III by the authors. In the process of platelet activation and lysis, the gold particles of GPIIb/IIIa were increasingly condensed. The possible reasons of increased surface expression of GPIIb/IIIa stimulated by HSS are also discussed.

     

Experimental and clinical studies on inhibitory effect of Ganoderma lucidum on platelet aggregation

Summary In this study we observed the inhibitory effect of Chinese herbal medicine Ganoderma lucidum (GL) on platelet aggregation in 15 healthy volunteers and 33 patients with atherosclerotic diseases. The results showed that the first and the second phase of aggregation of platelets of the healthy volunteers were obviously inhibited (P<0.0l) when watery soluble extract of GL of different concentrations was added to the platelets in vitro, i. e., the reaction speed of platelet aggregation was slowed down. The inhibitory effect was related to dosage. Platelet aggregation induced by ADP in final concentration of 2 μmol/L and 3 μmol/L was obviously inhibited, after the patients had taken GL 1 g 3 times a day for 2 weeks, the maximum platelet aggregation inhibition rates were then 31.49 % (P<0.0l) and 17.7 % (P<0.0l) respectively. Length and weights (wet and dry) of the extracorporeal thrombi were reduced from 30.05±4.38 mm, 103.9±9.33mg and 44.89±4.79 mg to 20.4±2.33 mm (P<0.05), 85.27±8.77 mg (P<0.0l) and 35.1=±4.5 mg (P<0.0l) respectively after oral administration of GL. The results of our experiments suggested that the Chinese herbal medicine GL may be an effective inhibitory agent of platelet aggregation. However, its mechanism and active principles remain to be further investigated.     

Antiplatelet therapy in non-ST-segment elevation acute coronary syndromes

Acute coronary syndromes are a frequent cause of hospital admission for patients with coronary artery disease. The pathophysiology of acute coronary syndromes often involves plaque rupture or fissure with platelet aggregation. Recognition of the importance of platelet aggregation resulted in several large randomized trials testing 3 types of platelet antagonists, aspirin, glycoprotein IIb/IIIa inhibitors, and adenosine diphosphate inhibitors. A thorough understanding of the data, risks, and benefits of these therapies is important to optimize treatment of the patient with an acute coronary syndrome. Recognition that there is a great deal of interpatient variability in response to these antiplatelet therapies highlights the need for future research in this area.     

复方银杏滴丸抗血栓及抑制血小板聚集作用实验研究

目的探讨复方银杏滴丸(CO-GBE)抗血栓形成及抑制血小板聚集的作用.方法①制造大鼠动静脉旁路血栓形成模型,测定血栓湿重及干重;②分别采用胶原、PAF、ADP诱导豚鼠血小板聚集,测定血小板在不同时间点的聚集率以及最大聚集率.结果.复方银杏滴丸 40、20、10 mg/kg均可以不同程度地抑制大鼠动静脉旁路血栓形成,减轻血栓干重及湿重(P<0.05,P<0.01);抑制不同诱导剂诱导的豚鼠血小板在不同时间点的聚集,降低其最大聚集率.结论.复方银杏滴丸可明显抗血栓形成,并具有高效广泛的血小板聚集抑制作用.     

Production and application of anti-human platelet GP IIb/IIIa monoclonal antibodies

Four types of anti-human platelet glycoprotein IIb/IIIa (GP IIb/IIIa)monoclonal antibodies (McAb), termed HIP2, HIP4, HIP7, HIP8, were obtained in our laboratory. All of them recognized GP IIb/IIIa complex except that HIP2 recognized GP IIb. As to the effect of the four McAbs on platelet aggregation, the results showed: 1) HIP4 and HIP8 can completely inhibit platelet aggregation induced by ADP or collagen, but not that induced by thrombin or ristocetin. 2) HIP2 was able to activate platelet aggregation directly. But it is Ca++ and complement dependent; 3) HIP7 did not show any effect on platelet aggregation induced by collagen, ADP, thrombin or ristocetin. When clinically studied, some cases of platelet-associated diseases such as thrombocytasthenia and thrombocytopenia had abnormal responses to the above McAbs. In addition, we also found that these McAbs can stimulate hematopoiesis in CFU-E assay.     

Evaluation of prolonged antithrombotic pretreatment ("cooling-off" strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial

Context  In unstable coronary syndromes, catheter intervention is frequently preceded by antithrombotic treatment to reduce periprocedural risk; however, evidence from clinical trials to support antithrombotic pretreatment is sparse. Objective  To test the hypothesis that prolonged antithrombotic pretreatment improves the outcome of catheter intervention in patients with acute unstable coronary syndromes compared with early intervention. Design, Setting, and Patients  Randomized controlled trial conducted from February 27, 2000, to April 8, 2002, and including patients admitted to 2 German tertiary care centers with symptoms of unstable angina plus either ST-segment depression or elevation of cardiac troponin T levels. Interventions  Patients were randomly allocated to antithrombotic pretreatment for 3 to 5 days or to early intervention after pretreatment for less than 6 hours. In both groups, antithrombotic pretreatment consisted of intravenous unfractionated heparin (60-U/kg bolus followed by infusion adjusted to maintain partial thromboplastin time of 60 to 85 seconds), aspirin (500-mg intravenous bolus followed by 100-mg twice-daily oral dose), oral clopidogrel (600-mg loading dose followed by 75-mg twice-daily dose), and intravenous tirofiban (10-µg/kg bolus followed by continuous infusion of 0.10 µg/kg per min). Main Outcome Measure  Composite 30-day incidence of large nonfatal myocardial infarction or death from any cause. Results  Of the 410 patients enrolled, 207 were allocated to receive prolonged antithrombotic pretreatment and 203 to receive early intervention. Elevated levels of cardiac troponin T were present in 274 patients (67%), while 268 (65%) had ST-segment depression. The antithrombotic pretreatment and the early intervention groups were well matched with respect to major baseline characteristics and definitive treatment (catheter revascularization: 133 [64.3%] vs 143 [70.4%], respectively; coronary artery bypass graft surgery: 16 [7.7%] vs 16 [7.9%]). The primary end point was reached in 11.6% (3 deaths, 21 infarctions) of the group receiving prolonged antithrombotic pretreatment and in 5.9% (no deaths, 12 infarctions) of the group receiving early intervention (relative risk, 1.96 [95% confidence interval, 1.01-3.82]; P = .04). This outcome was attributable to events occurring before catheterization; after catheterization, both groups incurred 11 events each (P = .92). Conclusion  In patients with unstable coronary syndromes, deferral of intervention for prolonged antithrombotic pretreatment does not improve the outcome compared with immediate intervention accompanied by intense antiplatelet treatment.      

瑞香素及其衍生物对2型糖尿病大鼠血液流变学影响的实验研究

目的:研究瑞香素及其衍生物对2型糖尿病血液流变学的影响。方法:采用高脂饮食结合小剂量应用链脲佐菌素(30mg·kg-1)建立实验性2型糖尿病(2型DM)大鼠模型。通过对大鼠血小板聚集率、全血黏度(高切、中切、低切)指标的检测,观察瑞香素及其衍生物对血液流变学影响。结果:与模型组比较,瑞香素组(0.5g·kg-1)、消渴丸组(3.0g·kg-1)及联合给药组(3.5g·kg-1)均能抑制ADP诱导的血小板聚集(P<0.01、P<0.05),瑞香素(0.5g·kg-1)、瑞香素衍生物(1.0g·kg-1、0.5g·kg-1)、消渴丸(3.0g·kg-1)及联合给药(3.5g·kg-1)均能降低全血黏度低切(P<0.05,P<0.01,P<0.001)。结论:瑞香素及其衍生物可明显改善2型DM大鼠血液流变学的异常。     

Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial

Context  No specifically designed studies have addressed the role of the glycoprotein IIb/IIIa inhibitor abciximab in patients with non–ST-segment elevation acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) after pretreatment with 600 mg of clopidogrel. Objective  To assess whether abciximab is associated with clinical benefit in high-risk patients with ACS undergoing PCI after pretreatment with 600 mg of clopidogrel. Design, Setting, and Patients  International, multicenter, randomized, double-blind, placebo-controlled study conducted from March 2003 through December 2005, enrolling 2022 patients (mean age, 66 years) with non–ST-segment elevation ACS undergoing PCI. Interventions  Patients were assigned to receive either abciximab (0.25 mg/kg of body weight bolus, followed by a 0.125-µg/kg per minute [maximum, 10 µg/min] infusion for 12 hours, plus heparin, 70 U/kg of body weight) or placebo (placebo bolus and infusion of 12 hours, plus heparin bolus, 140 U/kg). All patients received clopidogrel, 600 mg, at least 2 hours prior to the procedure, as well as 500 mg of oral or intravenous aspirin. Main Outcome Measures  The primary end point was a composite of death, myocardial infarction, or urgent target vessel revascularization occurring within 30 days after randomization; secondary end points were rates of in-hospital major and minor bleeding. Results  Of 2022 patients enrolled, 1012 were assigned to abciximab and 1010 to placebo. The primary end point was reached in 90 patients (8.9%) assigned to abciximab vs 120 patients (11.9%) assigned to placebo, a 25% reduction in risk with abciximab (relative risk [RR], 0.75; 95% CI, 0.58-0.97; P = .03). Among patients without an elevated troponin level, there was no difference in the incidence of primary end point events between the abciximab group (23/499 patients [4.6%]) and the placebo group (22/474 patients [4.6%]) (RR, 0.99; 95% CI, 0.56-1.76; P = .98), whereas among patients with an elevated troponin level, the incidence of events was significantly lower in the abciximab group (67/513 patients [13.1%]) compared with the placebo group (98/536 patients [18.3%]), which corresponds to an RR of 0.71 (95% CI, 0.54-0.95; P = .02) (P = .07 for interaction). There were no significant differences between the 2 groups regarding the risk of major and minor bleeding as well as need for transfusion. Conclusions  Abciximab reduces the risk of adverse events in patients with non–ST-segment elevation ACS undergoing PCI after pretreatment with 600 mg of clopidogrel. The benefits provided by abciximab appear to be confined to patients presenting with an elevated troponin level. Trial Registration  ClinicalTrials.gov Identifier: NCT00133003      

Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial

Context  In the Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE)-2 trial, bivalirudin with provisional glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibition was found to be noninferior to heparin plus planned Gp IIb/IIIa blockade in the prevention of acute ischemic end points and was associated with significantly less bleeding by 30 days after percutaneous coronary intervention (PCI). Objective  To determine whether the efficacy of bivalirudin remains comparable with that of heparin plus Gp IIb/IIIa blockade over 6 months and 1 year. Design, Setting, and Participants  Follow-up study to 1 year of a randomized, double-blind trial conducted among 6010 patients undergoing urgent or elective PCI at 233 community or referral hospitals in 9 countries from October 2001 through August 2002. Interventions  Patients were randomly assigned to receive intravenously bivalirudin (0.75 mg/kg bolus, 1.75 mg/kg per hour for the duration of PCI), with provisional Gp IIb/IIIa inhibition, or to receive heparin (65 U/kg bolus), with planned Gp IIb/IIIa inhibition (abciximab or eptifibatide). Both groups received daily aspirin and a thienopyridine for at least 30 days after PCI. Main Outcome Measures  Incidence of death, myocardial infarction, or repeat revascularization by 6 months and death by 12 months after enrollment. Results  At 6 months, death occurred in 1.4% of patients in the heparin plus Gp IIb/IIIa group and in 1.0% of patients in the bivalirudin group (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.43-1.14; P = .15). Myocardial infarction occurred in 7.4% and 8.2% of patients, respectively (HR, 1.12; 95% CI, 0.93-1.34; P = .24), and repeat revascularization was required in 11.4% and 12.1% of patients, respectively (HR, 1.06; 95% CI, 0.91-1.23; P = .45). By 1 year, death occurred in 2.46% of patients treated with heparin plus Gp IIb/IIIa blockade and in 1.89% of patients treated with bivalirudin (HR, 0.78; 95% CI, 0.55-1.11; P = .16). Nonsignificant trends toward lower 1-year mortality with bivalirudin were present in all patient subgroups analyzed and were of greatest magnitude among high-risk patients. Conclusion  Long-term clinical outcome with bivalirudin and provisional Gp IIb/IIIa blockade is comparable with that of heparin plus planned Gp IIb/IIIa inhibition during contemporary PCI.      

特发性血小板减少性紫癜患者血小板相关抗体的表达及意义

目的探讨特发性血小板减少性紫癜（ITP）患者患病时PAIg的表达评价其在ITP中的临床意义。方法选取40例ITP患儿作为研究对象,同期门诊体检正常儿童20例为对照组,应用酶联免疫吸附法（ELISA法）测定血小板相关抗体（PAIgA、PAIgG）、采取单克隆抗体特异性俘获血小板抗原（MAIPA法）测定血小板特异性抗体抗血小板膜糖蛋白抗体（GPIIb/IIIa、GPIb/IX）,全自动血液分析仪测定血小板计数。结果 PAIgA、PAIgG、GPIIb/IIIa、GPIb/IX、血小板计数对照组分别为（4.22±0.78）ng/107PA、（23.17±3.46）ng/107PA、（0.33±0.01）A值、（0.31±0.01）A值、（137.82±42.37）×109/L,ITP组分别为（45.58±5.32）ng/107PA、（243.34±12.21）ng/107PA、（0.42±0.06）A值、（0.41±0.05）A值、（35.50±21.35）×109/L,两组以上各项指标之间比较均差异有统计学意义（P〈0.05）;ITP组血小板计数与特异性抗体GPIIb/IIIa、GPIb/IX之间具有负相关,相关系数分别为-0.24（P〈0.05）、-0.31（P〈0.05）。结论在ITP患儿中血小板相关抗体及特异性抗体均有明显升高,呈现阳性表达,ELISA法、MAIPA法联合检测有助于鉴别免疫性与非免疫性血小板减少型紫癜,能提高早期诊断率,并且有助于指导临床治疗。     

蝮蛇毒蛋白C激活物的纯化与抗血小板活性

目的　研究蝮蛇毒蛋白C激活物 (PCA)组分对兔血小板聚集性的影响。方法　借助DEAE Cellulose、SP SephadexC 5 0及SP SephadexG 75柱层析 ,以离子交换和凝胶过滤法从江浙蝮蛇 (AHV)粗毒中分离纯化PCA抗凝组分 ;SDS 聚丙烯酰胺凝胶电泳 (SDS PAGE)检测其纯度和分子量。比浊法测定血小板聚集率。结果　从AHV分离纯化的PCA抗凝组分经SDS PAGE电泳测定为单一区带 ,相对分子质量为 14 0 0 0左右 ,等电点 pH 4 .7;该PCA在体外对由诱聚剂ADP诱导的血小板聚集呈剂量依赖性的抑制作用 ,其IC50 为 12 5 μg/ml。PCA(1.0mg/kg) 体内给药可逆性抑制血小板聚集反应。结论　从蝮蛇毒中纯化的这种PCA抗凝组分可通过抑制血小板聚集而影响血凝过程。     

靶控输注与间断静脉注射丙泊酚用于经皮微波消融治疗肝癌的麻醉效果比较

目的 比较肝癌患者在静脉麻醉下行超声引导下经皮微波消融治疗(PMCT)中,丙泊酚靶控输注(TCI)与间断静注的麻醉效果.方法 选择肝功能正常或轻度异常拟行超声引导下PMCT的肝癌患者38例,年龄35～65岁,体质指数(BMI)18～28 kg/m2,ASA Ⅰ～Ⅱ级,随机分为靶控输注组(T组,n=19)和间断静注组(Ⅰ...     

替罗非班对非ST段抬高急性冠脉综合征的治疗作用

目的观察盐酸替罗非班对非ST段抬高急性冠脉综合征患者血小板聚集率、血清sCD40L及高敏C反应蛋白（hs-CRP）水平的影响,并随访30d主要心血管事件。方法入选80例高危非ST段抬高急性冠脉综合征患者,所有入选患者随机分为两组：替罗非班组（40例）在接受常规治疗的基础上联合应用盐酸替罗非班,首先给予负荷量0．4μg／（kg·min）持续30min,继而给予维持量0．1μg／（kg·min）连续静脉滴注48h;常规治疗组（40例）仅接受常规药物治疗。于用药前和持续用药48h后,分别测定血小板聚集率、血清sCD40L和hs—CRP水平。结果常规治疗组与替罗非班组在持续用药48h后,血小板聚集率分别为（36．27±15．89）％、（9．04±6．16）％,与基线（49．88±11．81）％、（47．73±10．31）％比较均有下降,且替罗非班组下降幅度明显大于常规治疗组;替罗非班组的sCD40L水平由（1．69±1．16）ng／ml降至（0．54±0．48）ng／ml,有显著性差异,而常规治疗组下降不显著。治疗前后两组hs—CRP水平比较均无显著性差异（P〉0．05）。随访30d,替罗非班组2例有顽固性心绞痛发作;对照组5例有顽固性心绞通发作,1例再发心肌梗死,两组无显著性差异。结论对于高危非ST段抬高急性冠脉综合征患者,盐酸替罗非班可有效抑制血小板聚集,显著降低sCD40L水平,使用盐酸替罗非班安全有效。